Radiation dose and long term risk of cardiac pathology following radiotherapy and anthracyclin for a childhood cancer
Radiation dose and long term risk of cardiac pathology following radiotherapy and anthracyclin for a childhood cancer
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DOI：
10.1016/j.radonc.2006.08.020
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发表时间：
2006-10-01
影响因子：
5.7
通讯作者：
de Vathaire, Florent
中科院分区：
文献类型：
--
作者：
Guldner, Laurence;Haddy, Nadia;de Vathaire, Florent
目的：为了确定心脏状态的儿童15岁（yrs）或以上的实体瘤treatment.Patients和方法：447例患者中，229人进行了充分的研究，218人没有。建议对所有447例连续患者进行以下心脏评价：（1）由两名心脏病专家之一进行心脏多普勒超声检查;（2）心律和传导异常，包括24小时动态霍尔特心电图;（3）I-131-mIBG心肌造影;（4）静息时血清脑钠肽水平;（5）运动试验和最大摄氧量测量。结果：89例（39%）患者诊断为心脏疾病，其中心力衰竭24例，其他无症状心脏疾病65例。当调整潜在的混杂因素时，心脏疾病和心力衰竭风险分别是心脏接受的平均辐射剂量的线性（1戈伊时的ERR：26%）和线性二次（I戈伊时的ERR：19%）函数。阿霉素累积剂量和平均辐射剂量之间没有相互作用，心脏疾病的证据，但心脏衰竭的ERR/戈伊是较高的患者接受小于350 mg/m2的阿霉素。结论：长期的心脏病理可能是一个主要的医源性风险的儿童癌症幸存者。这项研究强烈强调了在放疗期间限制心脏照射的必要性，特别是对于同时接受阿霉素治疗或对阿霉素敏感的患者。(c)2006爱思唯尔爱尔兰有限公司保留所有权利。
Purpose: To determine the cardiac status in children 15 years (yrs) or more after a solid tumour treatment.Patients and Methods: Of the 447 patients, 229 were fully studied and 218 were not. The following cardiac evaluation was proposed to all the 447 consecutive patients: (1) cardiac Doppler US by one of two expert cardiologists; (2) cardiac rhythm and conduction abnormalities including 24-h holter ECG; (3) I-131-mIBG myocardial scintigraphy; (4) serum brain natriuretic peptide levels at rest; (5) an exercise test with VO2 max measurement. The radiation dose delivered to 7 points in the heart was estimated for all patients who had received radiotherapy.Results: Cardiac disorder was diagnosed in 89 evaluated patients (39%) including 24 heart failures and 65 other asymptomatic cardiac diseases. When adjusting on potential confounders, cardiac disorder and cardiac failure risks were respectively linear (ERR at 1 Gy: 26%) and linear-quadratic (ERR at I Gy: 19%) functions of the average radiation dose received to the heart. No interaction between cumulative dose of adriamycin and average radiation dose was evidenced for cardiac disorders, but the ERR/Gy of cardiac failure was higher for patients receiving less than 350 mg/m(2) of Adriamycin.Conclusion: Long term heart pathologies are probably one of the major iatrogenic risks encored by patients who survived a childhood cancer. This study strongly emphasizes the need to limit the heart irradiation during radiotherapy, particularly, for patients who also received or were susceptible to later received adriamycin. (c) 2006 Elsevier Ireland Ltd. All rights reserved.